HKS Smart Healthcare

Hospitals are huge energy consumers. Only fast-food restaurants use more energy. Saving $1 in energy equals $20 in new revenue (American Hospital Association 2009 based on 5  percent margin for U.S. hospitals). If efficiently designed, a facility can reap a 30 to 50 percent reduction in annual energy costs, which equates to significant added revenue.

Building Orientation and Passive Strategies Building orientation and passive strategies should be optimized before mechanical and active strategies are considered. Gunsolus suggests looking at the following building orientation and passive strategies:

• Respond to solar exposure
• Harvest the natural breezes
• Maximize natural daylight
• Select high-efficiency glass
• Consider exterior shading devices

Benefits of a Healthy Work Environment The largest healthcare expense for providers is staff salaries, benefits and insurance. Designing a sustainable facility that provides views to nature and introduces natural light may have intangible benefits that far exceed energy savings since they are a much larger piece of the financial pie. Gunsolus pointed out that a healthier workplace environment offers:

• Increases in employee productivity
• Decreases in nursing turnover rates by 7 percent (according to a Michigan State University Study, Bronson Methodist Hospital, Michigan)
• Decreases in employee tuberculin conversion rates (According to Annals of Internal Medicine, November 2000)
• Reduction in employee absenteeism

In addition, a healthier hospital environment provides:

• Recruiting advantages
• Better treatment outcomes
• Risk mitigation
• Improved public perception
• Reduced medical errors

Healthy Building Product Tips One of the most important developments in the last 10 to 15 years is a focus on identifying and using healthy building materials. Nowhere is this more important than the healthcare environment. To maximize a healthy building, Gunsolus suggests:

• Avoiding potentially harmful chemicals even if the extent of the potential damage is not certain
• Promoting product transparency by encouraging product suppliers to fully disclose the chemicals in their products. Health Product Declarations (HPDs), is a way of standardizing how chemical content is reported and is included in the forthcoming LEED v4.

Hospital success in the future will likely be tied to better Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Press Ganey scores, which define patient satisfaction and quality of care. Architects and engineers can certainly affect these criteria through design.

Heapy Engineering and Wright State University co-hosted the educational and networking event for healthcare providers and industry partners. The symposium began with a keynote luncheon followed by two panel discussions on sustainably based healthcare delivery, operations and management.

Cost reduction, waste elimination and collaboration are center stage in every hospital today. The  integrated, lean project delivery method addresses these issues and benefits hospitals with robust end-user involvement throughout the design process.

For the past year, architects, builders and Akron Children’s Hospital’s Lean Six Sigma process improvement team have been planning a new $200 million patient tower in Ohio. Using lean and evidence-based design principles, department teams at Akron, in conjunction with the architects, designed the new emergency department using small scale models, including paper doll cutouts, cups and yarn to identify types of rooms. Using a hands-on end user approach, the staff designed their ED using paper cutouts of individual rooms. Key adjacencies and the numbers and types of rooms were identified by the staff. Using block plans of each floor separated by plastic cups, colored yarn representing the seven flows of healthcare was used to note key inter- and intra-departmental adjacencies.

Architectural plans were tested in full-scale mock-ups constructed in a local warehouse. This allowed doctors, nurses and patients to walk down hallways, enter exam rooms and reach for supplies – catching potential problems well before the real construction begins.

Tips to Design Lean:

• Involve individuals from the value stream – each step involved in the process of delivering a service to the customer.
• Be prepared, but nimble with planning.
• Robust end user preparation is imperative to obtain the optimal outcomes.  Read the rest of this entry »

It doesn’t pay to incorporate a broken process into a new building, so say administrators at Children’s Medical Center Dallas and Children’s of Alabama. When designing their new facilities, they set out to do things differently.

These two hospitals had in-depth expansion project experience, but neither considered innovation during the process of facility design. Faced with pressure to produce outcomes in operational performance, patient satisfaction and physician approval that exceeded anything produced in the past, the systems knew they had to look at this challenge through a new lens.

Both systems engaged in breakthrough lean visioning and operational innovation sessions that mapped each functional activity (clinical, ancillary, support) and identified ways to radically improve the service that they were providing and change the way business is done. Every process was mapped and new leaders emerged with the redesigned processes. In the end, both the process and the product were noticeably different.

The Do’s and Don’ts of Lean Facility Planning

Do’s

• Listen to the voice of the customer.
• Engage the patients and families as much as possible.
• Learn from your current state – the good and the bad.
• Bring in a fresh set of eyes.
• Go to the gemba – the place where the work is being done.
• Give the staff ownership. When it becomes “their” process they will become the front line ambassadors for change.
• Work backward from a target goal so every meeting is purposeful and occurs at the right time.
• Sweat the small stuff.
  • It’s natural to spend lots of time on the big messy issues you are trying to solve, but some of the “minor details” can make a huge impact on day-to-day work at the bedside. Examples: diaper scale shelf in bathroom, deeper isolation supply cabinets, theft-proof gaming systems and task light for drawing labs.
• Embrace the use of mock-ups and encourage rapid prototyping.
• Require full participation from all stakeholders, and adopt an “equal voice” rule in meetings.
• Consider program development and operations concurrently with design and construction.
• Implement a comprehensive review of organizational workflow and downstream effects.
• Solicit more frontline staff input from onset of design through completion.
• Appreciate the complexity and importance of equipment planning.
• Use standardization as a primary guiding principle.
• Synchronize the approach of the technology and construction implementation schedule.
• Improve physician engagement.
• Establish leaders for each floor/area.
• Schedule and conduct meetings to meet their schedules.
• Provide updates that are pertinent to what they want to hear.
• Keep most decisions at project team level.
• Escalate unresolved issues to Executive Steering Committee.

Don’ts

• Underestimate the logistics of managing and facilitating large groups of people during this process.
• Get started too late – if you have the right team in place, operations should inform design, not vice-versa.
• Forget the power and importance of visioning – from your customer, your staff, administration, and your design and construction team.
• Deviate from principles of standardization.
• View the project as “facility-centric.”
• Avoid or postpone crucial conversations with staff and medical staff (transparency dispels many unrealistic expectations).
• Implement Electronic Medical Records and construction and occupancy of facility within close timeframes.
• Deviate from team/project goals.
• Conduct team sessions longer than two hours – if you do, provide food.
• Change direction after the final decision is made.
• Allow scope creep.

Natural light is one of the primary design drivers for the Benjamin Russell Hospital for Children.  The ability to bring in natural light and have views to the outside is important for the well-being of patients, staff, and families. Great effort went into making sure the public spaces and passageways had natural light and views and therefore were located on the perimeter of the hospital.  This helps significantly with way-finding by not traversing the through corridors buried in the bowels of the hospital.  The emergency department entrance was located along the same street as the main entry to minimize confusion when a parent brings a child during an emergency.

The emergency waiting is connected to the lobby by a glassed passage way along the perimeter.  Family areas and rest areas on the patient floors have views outside.  Large windows in the family zones of the patient rooms provide great views of downtown Birmingham and Red Mountain, an area landmark. There are even clerestory windows in the patient room toilets to bring in natural light.

Another important goal for the Benjamin Russell Hospital for Children was sustainability – to be a good neighbor to the community and the environment.  The major facades of the building are oriented north and south to minimize undue solar gain and heat. An added benefit is the best views from all the patient rooms are to the north (downtown Birmingham) and to the south (Red Mountain). The glass curtainwall is composed of energy efficient insulated low-e glass. Roof areas of the podium are planted with vegetation to help minimize storm water runoff and add insulation.  Plus, the roofs become pleasant

green spaces to view from the patient rooms above.    As a result and along with several other sustainable features, the Benjamin Russell Hospital for Children has achieved a silver LEED rating.